Provider Demographics
NPI:1841298007
Name:TROUM, STEPHEN J (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:J
Last Name:TROUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8450
Mailing Address - Fax:
Practice Address - Street 1:731 E SOUTHLAKE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6378
Practice Address - Country:US
Practice Address - Phone:817-335-4316
Practice Address - Fax:817-338-0342
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL06622086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141988901Medicaid
TX141988902Medicaid
TX8A1850OtherBCBS
TXP00074575OtherMEDICARE RAILROAD
TX141988901Medicaid
TX8A1850OtherBCBS
TX141988902Medicaid
TXP00074575OtherMEDICARE RAILROAD
TX141988902Medicaid